NAME AND ADDRESS:

PHONE / EMAIL:

HOW DID YOU HEAR ABOUT US?
PHILADELPHIA INQUIRER
PHILADELPHIA STYLE MAGAZINE
PHILADELPHIA MAGAZINE
SIGNAGE
BILLBOARD
DRIVE-BY
WEBSITE
BROKER
RADIO STATION

Other:

ARE YOU WORKING WITH A BROKER?*
------- Yes No

If Yes, what is their name?

DO YOU PRESENTLY:
OWN A SINGLE FAMILY HOME
OWN A CONDOMINIUM TOWNHOUSE
RENT

Other

Housing Size Preference:
------- Studio One Bedroom Two Bedroom Three Bedroom

AGE OF HEAD OF HOUSEHOLD:
------- Under 25 25-29 30-39 40-49 50-59 60+

FAMILY STATUS:
------- Single Married Roomate

WHAT I EXPECT TO PAY FOR MY HOME:
------- Less than $250,000 $250,001 - $500,000 $500,001 - $750,000 $750,001 - $1,000,000 Over $1,000,000

Reason for purchase:
------- Investment Primary Residence Secondary Residence Residence for Family Members

If you are currently working with a Broker they must accompany you on your first visit to the Dockside sales center and register you as their client.